Clinical and prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in breast cancer: a systematic review and meta-analysis
- 1Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
Abstract
BackgroundThe C-reactive protein-albumin-lymphocyte (CALLY) index integrates inflammatory, nutritional and immune-related biomarkers and may offer an accessible measure of host status in breast cancer. However, its prognostic relevance and clinical value remain uncertain. This systematic review and meta-analysis evaluated its associations with survival and treatment response and examined predictive performance.
MethodsPubMed, Embase, Scopus and Web of Science were searched from inception to 1 October 2026, supplemented by reference-list and forward-citation searching. Studies evaluating CALLY in adults with invasive breast cancer were eligible. Multivariable-adjusted hazard ratios (HRs) comparing low versus high baseline CALLY were pooled using restricted maximum likelihood random-effects models with modified Hartung-Knapp intervals. Risk of bias and evidence certainty were assessed using the Newcastle-Ottawa Scale and GRADE, respectively.
ResultsNine publications included 2,568 reported patients. Four studies comprising 1,394 patients contributed to each survival synthesis. Low CALLY yielded pooled HRs of 2.03 for overall survival (95% CI 1.20-3.45; I{superscript 2}=72.4%) and 2.00 for disease-free survival (95% CI 0.91-4.41; I{superscript 2}=77.7%). Both intervals included no association. In one HER2-positive cohort, low baseline CALLY was associated with lower odds of pathological complete response (adjusted OR 0.25, 95% CI 0.12-0.50). Apparent overall-survival area under the receiver-operating-characteristic curve (AUC) ranged from 0.688 to 0.740. External validation and demonstrated clinical utility were absent.
ConclusionsCALLY shows potential prognostic and treatment-response associations, but imprecision, heterogeneity and limited validation prevent routine clinical adoption. Standardized measurement, prospective validation and demonstration of incremental clinical value are needed.
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BibTeX
@misc{rad2026clinical,
title = {{Clinical and prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in breast cancer: a systematic review and meta-analysis}},
author = {K. Jalalian Rad and S. Kadri and A. Yakiti and S. Ghasemi and H. hadizadeh moallem and S. Noei Teymoordash and D. Yarahmadi},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.22.26366242},
url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26366242v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Clinical and prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in breast cancer: a systematic review and meta-analysis
AU - K. Jalalian Rad
AU - S. Kadri
AU - A. Yakiti
AU - S. Ghasemi
AU - H. hadizadeh moallem
AU - S. Noei Teymoordash
AU - D. Yarahmadi
PY - 2026
DA - 2026/10/22
PB - medRxiv
DO - 10.64898/2026.10.22.26366242
UR - https://www.medrxiv.org/content/10.64898/2026.10.22.26366242v1
AB - BackgroundThe C-reactive protein-albumin-lymphocyte (CALLY) index integrates inflammatory, nutritional and immune-related biomarkers and may offer an accessible measure of host status in breast cancer. However, its prognostic relevance and clinical value remain uncertain. This systematic review and meta-analysis evaluated its associations with survival and treatment response and examined predictive performance. MethodsPubMed, Embase, Scopus and Web of Science were searched from inception to 1 October 2026, supplemented by reference-list and forward-citation searching. Studies evaluating CALLY in adults with invasive breast cancer were eligible. Multivariable-adjusted hazard ratios (HRs) comparing low versus high baseline CALLY were pooled using restricted maximum likelihood random-effects models with modified Hartung-Knapp intervals. Risk of bias and evidence certainty were assessed using the Newcastle-Ottawa Scale and GRADE, respectively. ResultsNine publications included 2,568 reported patients. Four studies comprising 1,394 patients contributed to each survival synthesis. Low CALLY yielded pooled HRs of 2.03 for overall survival (95% CI 1.20-3.45; I{superscript 2}=72.4%) and 2.00 for disease-free survival (95% CI 0.91-4.41; I{superscript 2}=77.7%). Both intervals included no association. In one HER2-positive cohort, low baseline CALLY was associated with lower odds of pathological complete response (adjusted OR 0.25, 95% CI 0.12-0.50). Apparent overall-survival area under the receiver-operating-characteristic curve (AUC) ranged from 0.688 to 0.740. External validation and demonstrated clinical utility were absent. ConclusionsCALLY shows potential prognostic and treatment-response associations, but imprecision, heterogeneity and limited validation prevent routine clinical adoption. Standardized measurement, prospective validation and demonstration of incremental clinical value are needed.
ER -